Scans - PET-CT, etc.

Here's the pdf for this presentation: Inherited T790M EGFR Mutation

This week, the American Academy of Family Physicians (AAFP) elected to not follow the lead of the more influential US Preventive Services Task Force (USPSTF), which previously reviewed the information on chest CT screening for high risk patients and recommended it, and

One of the challenges of the increased frequency of chest CT scans being done for screening of people at higher risk of lung cancer, or done more commonly for chest symptoms, is that lung nodules are very commonly found, but most the time they aren't cancer.  Most studies show that >90% of lung nodules are benign, but the majority lead to additional work-up, and in nearly 100% of cases, they cause anxiety for the patient. What if a blood test could help clarify the probability that someone doesn't have a lung cancer?

Dr. David Gerber, University of Texas-Southwestern, reviews results from RTOG 0617 that help clarify the optimal dose of radiation for stage III unresectable NSCLC.

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The most pivotal study supporting the value of screening for lung cancer is the National Lung cancer Screening Trial (NLST), which revealed a 20% improvement in overall survival in patients with sufficiently high risk of lung cancer and who underwent an annual chest CT scans vs. chest x-ray over a three year period.

Dr. Ravi Salgia from the University of Chicago discusses the trend of patients consulting Dr.Google - finding information of varied quality on the internet.

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Dr. Heather Wakelee from Stanford University offers her insights on how to approach a patient with gradual progression in a single site, especially in the brain, or more multifocal progression after a good initial response to a targeted agent for lung cancer.

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I just did a brief video for Swedish Medical Center on the issue of low dose CT screening for lung cancer, which has been proven to improve survival.  Though Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society, just wrote a book about the risk of over-diagnosis of cancer, the ACS has just officially endorsed lung cancer screening, recognizing its value.

The only problem is that it really isn't being done. I discuss a bit on the resistance to screening here:

Malignant pleural mesothelioma (MPM) is a challenging cancer to treat for many reasons, one of which being the difficulty in assessing whether there has been any meaningful change in the volume of a cancer that doesn't tend to appear as a discrete mass, but most commonly as thickening of the pleura, the lining around the lung that is normally a thin, onion skin, but can thicken to be more like an orange rind or even thicker.  We can often see this pattern in some people with lung cancer who happen to have a form of the disease that also primarily appears as pleural-based deposits of ca